2. Ionic calcium
• is crucial for many biochemical
processes including
• blood coagulation,
• neuromuscular excitability,
• cell membrane integrity, and
• many of the cellular enzymatic activities.
6. Serum calcium (SCa) in the
fetus is 10-11 mg/dL at term
(1-2 mg higher as compared to
mother).
7. After birth
•
•
•
•
•
•
PTH secretion,
Dietary calcium intake,
renal calcium reabsorbtion,
skeletal calcium stores
vitamin D status.
7.5-8.5 mg/dL in healthy term babies by day
2 of life.
8. DROP IN CA LEVEL
• CAUSES
• hypoparathyroidism,
• end organ unresponsiveness to parathyroid
hormone
• abnormalities of vitamin Dmetabolism,
hyperphosphatemia,
• hypomagnesemia, and hypercalcitonemia
9. Calcium homeostasis in
newborn
• two major compartments
• skeleton (99%)
• extracellular fluid (1%).
– bound to albumin (40%)
– bound to anions 10%
– free ionized form(50%)
5
11. Definition
• Hypocalcemia is defined as total serum
calcium of less than 7 mg/dL (1.75mmol/L)
or ionized calcium less than 4 mg/dL (1
mmol/L) in preterm infants and less than 8
mg/dL (2 mmol/L; total) or <1.2 mmol/L
(ionic) in term neonates
13. Screening is recommended
in at risk neonates
• 1.Preterm infants born before 32 wks
• 2. Infants of diabetic mothers on iv fluids
• 3.Infants born after severe perinatal
asphyxia
20. Treatment of early onset
hypocalcemia
• Prophylactic
• Preterm infants (£32 weeks), sick infants of
diabetic mothers. severe perinatal asphyxia
should receive 40 mg/kg/day of
• elemental calcium (4 mL/kg/day of 10%
calcium gluconate)
22. Symptomatic hypocalcemia
• bolus dose of 2 mL/kg/dose diluted 1:1 with
• 5% dextrose over 10 minutes under cardiac
monitoring
• severe hypocalcaemia with poor cardiac
function,
• calcium chloride 20 mg/kg may be given
through a central line over 10-30 minutes
23. • continuous IV infusion of 80 mg/kg/day
elemental calcium for 48 hours
• Continuous infusion is preferred to IV bolus
doses (1 mL/kg/dose q 6hourly).
24. Management of early
neonatal hypocalcaemia
• Hypocalcemia
• Total serum Cal <7 mg/dl
• Asymptomatic
• 80 mg/kg/day for 48 hrs
• (8 mL/kg/day of 10% calcium gluconate )
• Taper to 40 mg/kg/day for one day
• Then stop
25. Symptomatic
• Bolus of 2 mL/kg calcium gluconate 1:1
diluted with 5 % dextrose
• over 10 minutes under cardiac monitorin
• Followed by continuous infusion 80
mg/kg/day for 48 hrs
• (8 mL/kg/day of 10% calcium gluconate )
• Document normal calcium at 48 hrs
26. • Then taper to 40 mg/kg/day for one day
• Then stop
• Prophylactic
• Preterm< 32 wks, sick IDM, severe asphyxia
• 40 mg/kg/day for 3 days
• (4ml/kg/day of 10% calcium gluconate )
• IV or oral if can tolerate per oral
27. • Treatment is for 72 hours
• Continuous infusion is better than bolus
• Symptomatic babies treatment is 48 hrs
continuous
infusion
28. Precautions and side effects
•
•
•
•
Bradycardia and
arrhythmia
extravasation
subcutaneous tissue necrosis.
29. Prolonged or resistant
hypocalcemia
• Symptomatic hypocalcemia unresponsive to
therapy
• · Infants needing calcium supplements
beyond 72 hours of age
• · Hypocalcemia presenting at the end of the
first week
30. Late onset neonatal
hypocalcemia (LNH)
• symptomatic in the form of neonatal tetany
or seizures
• 1. Hypomagnesemia
• 0.2 mL/kgof 50% MgSO4 injection, 12 hours
apart, deep IM
• Maintenance dose of 0.2 mL/kg/day of 50%
MgSO4, PO for 3 days.
31. • 2. High phosphate load
• 3. Hypoparathyroidism
• calcium (50 mg/kg/day in 3 divided doses)
and 1,25(OH)2 Vitamin D3 (0.5-1 mg/day).
• 4. Vitamin D deficiency states
